Ask the Doctors - Are there any natural remedies for arthritis pain?

Dr. Robert Ashley, MD

Dear Doctor: Are there natural remedies for arthritis? Exercises that could help? My pain is in the upper arms and shoulders.

Osteoarthritis, the kind that you’re describing, is the most common type of arthritis. It’s caused by degeneration of the cartilage within a joint. Cartilage is a tissue that provides cushion to the joint. Without the cartilage, one bone rubs upon the other, leading to pain and degeneration of the bone. Athletes can get arthritis due to recurrent injury and stress upon a joint, but most adults develop arthritis from wear and tear over time. This can affect the hips, knees, shoulders, wrists and fingers.

Doctors typically recommend non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen naproxen and aspirin; acetaminophen; and, more rarely, opiates for arthritis pain. These medications can help pain in the short term, but they don’t repair the cartilage or provide long-term pain relief – and they each carry risk. NSAIDs can increase the risk of stomach ulcers and kidney problems when used chronically; acetaminophen at high doses can cause liver problems when used chronically; and opiate medications can lead to addiction. So I can understand your desire to look for an alternative for the pain.

The supplements chondroitin sulfate and glucosamine have been used for osteoarthritis for years. Chondroitin is one of the building blocks of cartilage in our body, so many people naturally believe that taking chondroitin can decrease the pain of arthritis. A 2015 review of 43 randomized trials compared the use of chondroitin alone or in combination with glucosamine against the use of a placebo. Most of these studies looked at treatment for arthritis of the knees, with some looking at arthritis of the hips and hands. The studies measured pain on a 100-point scale. The use of chondroitin was found to be beneficial, whether with or without glucosamine, showing an small 8-point difference in pain compared with placebo. However, in regards to the stiffness and lack of mobility associated with arthritis, chondroitin was not found to be beneficial.

In 2016, a randomized trial of 606 patients with pain from osteoarthritis of the knee compared the use of glucosamine with chondroitin against the anti-inflammatory drug celecoxib (Celebrex). Glucosamine was dosed at 500 milligrams three times per day and chondroitin at 400 milligrams per day. After six months, the study found a significant decrease in pain of 50.1 percent with the glucosamine/chondroitin combination and a 50.2 percent decrease in pain with celexocib. Both groups found a greater than 50 percent reduction in joint swelling. What was interesting about the study was that it took a while for the glucosamine/chondroitin to work. At 1-4 months Celebrex was much better at improving pain, but at 6 months was no different than the glucosamine/chondroitin combination. So with the use of glucosamine and chondroitin, it is important to be patient.

Now these studies mostly looked at arthritis of the knee, but not of the shoulders, so I’m not sure the glucosamine or chondroitin would have benefit. The supplements MSM (methylsulfonylmethane) and DMSO (dimethyl sulfoxide) are anti-inflammatory agents that have been studied in arthritis of the knees without evidence of benefit, but it’s possible they could decrease pain in the joints of the hands. Arnica montana is a plant-based therapy that has some potential in topical use for pain relief, in that one study found a slight benefit for arthritis of the hands. Topical use of capsaicin cream, made from chili peppers, has shown potential as well, specifically in the application of the cream four times per day for arthritis of the knee. Note that, although the cream provided pain relief, it also has the potential to cause a significant burning sensation.

It is all a little confusing, no? Other natural remedies and supplements, such as fish oil, are touted for arthritis, but their use has not been well studied.

Glucosamine and chondroitin, on the other hand, have been studied for arthritis, though not for the shoulders specifically.

As for specific exercises, I would recommend physical therapy to increase your range of motion for your shoulder and to help increase your muscular strength. Yoga, pilates and tai chi can also be beneficial, potentially increasing your range of motion without undue stress on your already aching joints. Over time, you may well see a difference in your ability to function with less pain.

Robert Ashley, MD, is an internist and assistant professor of medicine at the University of California, Los Angeles.

Ask the Doctors is a syndicated column first published by UExpress syndicate.